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  • 1.
    Anbäcken, Els-Marie
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gustafsson, Lena-Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Zander, Viktoria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Östlund, Gunnel
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    A holistic way ofworking interprofessionally in home care with and for older people2016Conference paper (Refereed)
  • 2.
    Bernson, J. M.
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare.
    Hakeberg, M.
    Sahlgrenska Academy, University of Gothenburg.
    Dental coping strategies, general anxiety, and depression among adult patients with dental anxiety but with different dental-attendance patterns2013In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 121, no 3 PART 2, p. 270-276Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to investigate dental coping strategies, general anxiety, and depression in relation to regularity of dental treatment among persons with either regular dental care or phobic avoidance, whilst controlling for sociodemographic factors. Psychometric questionnaires on dental anxiety, dental coping strategies, general anxiety, and depression were delivered to 263 adult patients with dental phobic avoidance behavior who were seeking help from a specialized dental fear clinic and to 141 adult patients with dental anxiety who were receiving regular dental care from various public dental clinics. The results showed that the levels of dental and general anxiety and of depression were significantly higher among irregular attendees compared with regular attendees. Irregular attendees admitted fewer adaptive coping strategies. Predictive of irregular dental care were gender, dental anxiety, general anxiety, and the nonuse of the coping strategy 'optimism'. This study further confirms earlier preliminary results that the use of optimistic thinking is predictive for regular dental attendance habits and that male gender is a risk factor for irregular attendance. Moreover, this study adds that a high level of general anxiety indicates a higher risk for irregular dental care. © 2013 Eur J Oral Sci.

  • 3.
    Bernson, Jenny
    et al.
    University of Gothenburg, Institute of Odontology, Department of Behavioral and Community Dentistry.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare.
    Hakeberg, Magnus
    University of Gothenburg, Institute of Odontology, Department of Behavioral and Community Dentistry.
    Adaptive coping strategies among adult patients with dental fear: Further development of a new version of the Dental Coping Strategy Questionnaire2012In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 70, no 5, p. 414-420Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this study was to further develop and investigate a newly constructed 15-item questionnaire on strategies for coping with dental treatment, used by fearful adult patients undergoing regular dental care and those with phobic avoidance. Materials and Methods. The dental coping strategy questionnaire (DCSQ-15) was distributed to 77 individuals with dental phobic avoidance and 94 fearful patients undergoing regular dental care. Previous analyses of a 20-item coping questionnaire (DCSQ-20) revealed that 2 of 4 identified factors predicted regularity or phobic avoidance of dental care. However, one of these factors was considered related to catastrophizing thoughts and not to coping strategies and it was therefore removed in the present study. Results. The reduced 15-item questionnaire was analyzed to identify its factor structure and a 5-factor solution was found. The five factors were labeled (i) 'self-efficacy', (ii) 'self-distraction', (iii) 'distancing', (iv) 'praying' and (v) 'optimism'. The factors of 'praying' and 'optimism' correlated significantly with dental anxiety and were assessed significantly higher and lower respectively, among individuals with phobic avoidance. A logistic regression analysis revealed that 'optimism', together with gender and dental anxiety, was predictive of the regularity or phobic avoidance of dental care.

  • 4.
    Bernson, Jenny
    et al.
    University of Gothenburg, Institute of Odontology, Department of Behavioral and Community Dentistry.
    Hallberg, Lillemor R.-M.
    Halmstad University, School of Social and Health Sciences.
    Elfström, Magnus
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Hakeberg, Magnus
    University of Gothenburg, Institute of Odontology, Department of Behavioral and Community Dentistry.
    “Making dental care possible – a mutual affair”: A grounded theory relating to adult patients with dental fear and regular dental treatment2011In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 119, no 5, p. 373-380Article in journal (Refereed)
    Abstract [en]

    Dental fear is a common and widespread problem, which can cause severe stress. Even so, most patients with dental fear undergo regular dental treatment in spite of their fear and many enjoy good oral health. The aim of this study was to obtain a deeper understanding of how patients with dental fear manage to undergo dental treatment. Fourteen patients with dental fear, who undergo regular dental care, were interviewed. Qualitative analysis of the transcribed interviews was performed according to the principles of grounded theory. A conceptual framework was generated, and the main concern was identified as making dental care possible – a mutual affair. Four additional categories explained how patients handled their dental fear and how dental care became possible. The strategies were labelled taking part in a mental wrestling match, trust-filled interaction with dental staff, striving for control and seeking and/or receiving social support. The results showed that making dental care possible for patients with dental fear is a mutual challenge that requires interplay between dental staff and patients, involving verbal and non-verbal communication reflecting respect, attention, and empathy. Moreover, a balance between nearness and distance and between professional and personal treatment is required.

  • 5.
    Bernson, Jenny M
    et al.
    Public Dental Service, Göteborg, Sweden.
    Elfström, Magnus L
    Sahlgrenska Academy, Göteborg, Sweden.
    Berggren, Ulf
    Sahlgrenska Academy, Göteborg, Sweden.
    Self-reported dental coping strategies among fearful adult patients: preliminary enquiry explorations.2007In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 115, no 6, p. 484-490Article in journal (Refereed)
    Abstract [en]

    This investigation explored strategies to cope with dental treatment used by fearful adult patients undergoing regular dental care and those with phobic avoidance. A newly constructed 20-item questionnaire entitled The Dental Coping Strategy Questionnaire (DCSQ-20) was distributed consecutively to 171 individuals with self- and dentist-reported high dental fear, of whom 77 had dental phobic avoidance and were attending a dental fear clinic and 94 were undergoing regular care at one of three different public dental clinics. The level of dental fear was high in both groups, but significantly higher among avoidant individuals. Several of the DCSQ-20 items showed statistically significant differences between groups. Factor analysis of the DCSQ-20 yielded a four-factor solution explaining 52% of the total variance. The factors were labelled (i) 'self-efficacy statements', (ii) 'self distraction and distancing', (iii) 'catastrophizing', and (iv) 'praying and despair'. The DCSQ-20 displayed sound psychometric properties, and the reliability (Cronbach's alpha) for the factors was between 0.68-0.78. Factors (iii) and (iv) correlated significantly with dental anxiety and were rated significantly higher among individuals with phobic avoidance. In a logistic regression analysis, gender, dental anxiety, and three of the four factors (i, iii, iv) were predictive of regularity vs. phobic avoidance of dental care.

  • 6.
    Boman, Ulla W
    et al.
    Sahlgrenska akademin vid Göteborgs universitet, Institutionen för odontologi.
    Lundgren, Jesper
    Göteborgs universitet, Psykologiska institutionen.
    Elfström, Magnus
    Sahlgrenska akademin vid Göteborgs universitet, Institutionen för medicin, Sektionen för vårdforskning.
    Berggren, Ulf
    Sahlgrenska akademin vid Göteborgs universitet, Institutionen för odontologi.
    Common use of a Fear Survey Schedule for assessment of dental fear among children and adults2008In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 18, no 1, p. 70-76Article in journal (Refereed)
    Abstract [en]

    Background.

    Little is known about children with dental fear (DF) in a long-term perspective. Measures of DF suitable for use among children, adolescents, and adults would be of value for longitudinal and family studies.

    Aim.

    Our aim was to explore the DF subscale of the Children’s Fear Survey Schedule (CFSS-DS) in highly fearful adult dental patients.

    Design.

    The subjects were 230 adult patients applying for treatment for severe DF at a specialized DF clinic. Questionnaires investigated background data, general fear and DF, and general anxiety and depression. Reference data were obtained from 36 nonfearful patients on a subset of questionnaires.

    Results.

    The fearful group reported high levels of DF on all measures and at a level similar to children with severe DF. The DF measures clearly differed between the fearful and reference groups. A factor analysis revealed a three-factor structure (fear of dental treatment, medical treatment, and of strangers and choking), which explained 68% of the variance.

    Conclusion.

    The CFSS-DS appears suitable for use in studies of adult populations. The results indicated that some areas of DF (physiology, avoidant behaviour, anticipatory anxiety), areas of importance among adult patients, are not assessed by the CFSS-DS. Studies of adults should therefore also include established adult measures of DF.

  • 7.
    Bonanno, George A.
    et al.
    Department of Counseling and Clinical Psychology, Teachers College, Columbia University .
    Kennedy, Paul
    Oxford Doctoral Course in Clinical Psychology, Oxford University and Stoke Mandeville Hospital, The National Spinal Injuries Centre, Department of Clinical Psychology.
    Galatzer-Levy, Isaac R.
    Department of Psychiatry, New York University School of Medicine .
    Lude, Peter
    Swiss Paraplegic Research and Swiss Paraplegic Center, Notwil.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare.
    Trajectories of resilience, depression and anxiety following spinal cord injury2012In: Rehabilitation Psychology, ISSN 0090-5550, E-ISSN 1939-1544, Vol. 57, no 3, p. 236-247Article in journal (Refereed)
    Abstract [en]

    Purpose/Objective: To investigate longitudinal trajectories of depression and anxiety symptoms following spinal cord injury (SCI) as well as the predictors of those trajectories. Research Method/Design: A longitudinal study of 233 participants assessed at 4 time points: within 6 weeks, 3 months, I year, and 2 years from the point of injury. Data were analyzed using latent growth mixture modeling to determine the best-fitting model of depression and anxiety trajectories. Covariates assessed during hospitalization were explored as predictors of the trajectories. Results: Analyses for depression and anxiety symptoms revealed 3 similar latent classes: a resilient pattern of stable low symptoms, a pattern of high symptoms followed by improvement (recovery), and delayed symptom elevations. A chronic high depression pattern also emerged but not a chronic high anxiety pattern. Analyses of predictors indicated that compared with other groups, resilient patients had fewer SCI-related quality of life problems, more challenge appraisals and fewer threat appraisals, greater acceptance and fighting spirit, and less coping through social reliance and behavioral disengagement. Conclusion/Implications: Overall, the majority of SCI patients demonstrated considerable psychological resilience. Models for depression and anxiety evidenced a pattern of elevated symptoms followed by improvement and a pattern of delayed symptoms. Chronic high depression was also observed but not chronic high anxiety. Analyses of predictors were consistent with the hypothesis that resilient individuals view major stressors as challenges to be accepted and met with active coping efforts. These results are comparable to other recent studies of major health stressors.

  • 8.
    Bose, C. Nahlen
    et al.
    Karolinska Inst, Stockholm, Sweden..
    Bjorling, G.
    Karolinska Inst, Stockholm, Sweden.;Red Cross Univ Coll, Stockholm, Sweden..
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Persson', H.
    Karolinska Inst, Dept Clin Sci, Danderyd Hosp, Stockholm, Sweden..
    Saboonchi, F.
    Karolinska Inst, Stockholm, Sweden.;Red Cross Univ Coll, Stockholm, Sweden..
    ASSESSMENT OF COPING IN A CHRONIC HEART FAILURE PATIENT POPULATION: THE BRIEF COPE RESTRUCTURED2014In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 21, p. S17-S17Article in journal (Other academic)
  • 9.
    Bose, C. Nahlen
    et al.
    Karolinska Inst, Stockholm, Sweden.
    Bjorling, G.
    Karolinska Inst, Stockholm, Sweden.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Persson, H.
    Karolinska Inst, Stockholm, Sweden.
    Saboonchi, F.
    Karolinska Inst, Stockholm, Sweden.
    Implementation of coping effectiveness training in patients with chronic heart failure: participants evaluations indicate psychosocial benefits2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, p. S10-S10Article in journal (Refereed)
  • 10.
    Eklund, Caroline
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Eriksson, Yvonne
    Mälardalen University, School of Innovation, Design and Engineering, Innovation and Product Realisation.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Development of the web application My Stress Control—Integrating theories and existing evidence2018In: Cogent Psychology, Vol. 5, no 1, p. 1-19Article in journal (Refereed)
    Abstract [en]

    Aim: To describe the systematic development of an evidence-based, tailored, interactive web application for self-management of work-related stress, and to test usability issues regarding how to proceed through the programme. Methods: Evidence from the fields of stress management, behaviour change and web-based interventions was the foundation for the theoretical framework and content. The next step was the development process of the web application and validation among experts and one possible end user. Last, a usability test with 14 possible end users was conducted. Results: The web-application, My Stress Control (MSC), was built on a solid theoretical framework. It consists of 12 modules including: introduction, psychoeducation, ambivalence, stress management strategies, lifestyle change, and maintenance. Self-monitoring, goal-setting, re-evaluating goals, feedback, and prompting formulation of intention to change are central techniques supporting behaviour change. The usability test revealed difficulties in understanding how to proceed through the programme. Conclusion: The development contributes to filling a gap in the literature regarding development of complex web-based interventions. MSC is dissimilar to existing programs in the field, considering the tailoring and multi-tracked opportunities. Although developed from the evidence in multiple fields, the web application would benefit from further development to support users in reaching the end module.

  • 11.
    Eklund, Caroline
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Eriksson, Yvonne
    Mälardalen University, School of Innovation, Design and Engineering, Innovation and Product Realisation.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Evaluation of a Web-Based Stress Management Application: A Feasibility Study2018In: Journal of Technology in Behavioral Science, ISSN 2366-5963, Vol. 3, no 3, p. 150-160Article in journal (Refereed)
    Abstract [en]

    The aim of the current study was to investigate the feasibility of a Web-based program that promotes behavior change for stress-related problems in terms of the program’s acceptability, practicability, and any possible effects. In addition, the aim was also to study how appropriate and realistic the study’s process and resource management would be for conducting a randomized controlled trial. A convenience sample consisting of 14 individuals was recruited from a university in Sweden. The participants had access to the program for a duration of 9 weeks. Questionnaires were answered before accessing, during use of, and after completing the program. Both qualitative and quantitative data were collected and analyzed. The program was considered acceptable and practically feasible, though small adjustments have to be made. The program was considered time-consuming, extensive, and in need of some clarifications. Regarding process and resource management, the study participants required minimum support. It was difficult to identify the time point when to send out the process measures because the participants worked at their own pace. Also, one of the process measurements, the motivation to change, remained stable. With some adjustments to the instructions to the study participants and minor changes in the program, the intervention and study’s procedure were considered as feasible and can be carried out in a randomized controlled trial.

  • 12.
    Eklund, Caroline
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Eriksson, Yvonne
    Mälardalen University, School of Innovation, Design and Engineering, Innovation and Product Realisation.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    User experiences from a web-based, self-management programme: struggling with what I need when stress management is about me2019In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, p. 39-48Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore users’ experiences of a tailored, interactive web application that supports behaviour change in stress management and to identify if and in that case what in the web-based programme that needed further development or adjustment to be feasible in a randomised controlled trial.

    Method: The design of this study was explorative with a qualitative approach. Nine individuals were recruited among the staff at a university. Semi-structured individual interviews were conducted and analysed using qualitative content analysis, after the participants had completed the web-based stress management programme.

    Results: One theme was identified, Struggling with what I need when stress management is about me, describing the paradox in having a programme that is perceived as supporting stress management while also being perceived as extensive and time consuming. The theme was divided in two categories: Defining the needs, where the users expressed what they needed from the programme and their everyday environment, to be able to use the programme, and It is about me, where the programme was described as helping the users understand their own stress.

    Conclusion: The participants expressed acceptance of using a web-based programme for stress related problems. The perceived extensiveness of the programme must be considered in further development.

  • 13.
    Eklund, Caroline
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Söderlund, Anne
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Evaluation of the web application My Stress Control, a stress management program for persons experiencing work related stress: A randomized controlled trialIn: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558Article in journal (Refereed)
  • 14.
    Elfström, Magnus
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Evans, C.
    Nottinghamshire Healthcare NHS Trust.
    Lundgren, J.
    University of Gothenburg.
    Johansson, B.
    University of Gothenburg.
    Hakeberg, M.
    University of Gothenburg.
    Carlsson, S. G.
    University of Gothenburg.
    Validation of the Swedish version of the clinical outcomes in routine evaluation outcome measure (CORE-OM)2013In: Clinical Psychology and Psychotherapy, ISSN 1063-3995, E-ISSN 1099-0879, Vol. 20, no 5, p. 447-455Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to perform an initial validation of a Swedish translation of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). The CORE-OM is a broad self-report instrument of psychological problems, designed as an outcome measure for evaluating the effects of psychological therapy. Participants included a non-clinical group of 229 university students and a clinical group of 619 persons from four primary care sites. The Swedish CORE-OM showed excellent acceptability, high internal consistency and test-retest reliability, as well as acceptable convergent validity. There was strong differentiation of the clinical and non-clinical samples, with the clinical group scoring significantly more psychological problems than the non-clinical group. Sensitivity to change was demonstrated in psychological treatments in primary care. Overall, the psychometric characteristics of the Swedish CORE-OM were very similar to the original UK data. Nevertheless, the validity of the Swedish version needs to be examined more in detail, in larger and more diverse samples. Our results so far, however, provide support for using the Swedish CORE-OM as a psychological problems measure. To our knowledge, there are few other relatively short measures in Swedish that are free to reprint that meet the demands for psychometric properties and utility in primary care settings in which patients typically present a broad range of psychological problems.

  • 15.
    Elfström, Magnus
    et al.
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Kennedy, Paul
    University of Oxford, UK.
    Lude, Peter
    Swiss Paraplegic Centre, Nottwil and Zurich University of Applied Sciences, Suisse .
    Predicting emotional well being during acute rehabilitation in a European spinal cord injury sample2009In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, p. 162-Article in journal (Other academic)
    Abstract [en]

    The purpose of this study was to examine what resource and coping variables that could predict emotional well being during the acute phase of spinal cord injury rehabilitation. All newly acquired injuries were approached in selected British, Swiss, Swedish, German, Austrian and Irish spinal centres. Participants were asked to complete a questionnaire booklet at 6 weeks post injury and again at 12 weeks. Stepwise hierarchical regression analyses were performed on data from 281 questionnaire packs from 14 European spinal centres. Gender, age and severity of impairment were controlled for. Sense of coherence, the coping strategy social reliance, threat and challenge appraisals, perceived manageability, and perceived quality of social support made significant contributions to the variance in measures of emotional well-being (anxiety, depression and a psychological subscale of a quality of life scale). Psychological assessment during acute stages may assist in identifying ‘at risk’ patients and provide guidance for therapeutic intervention.

  • 16.
    Elfström, Magnus
    et al.
    Sahlgrenska Academy at Göteborg University, Institute of Medicine.
    Kennedy, Paul
    University of Oxford, Isis Education Centre.
    Lude, Peter
    Private practice, Zurzach, Switzerland.
    Taylor, Nicola
    Stoke Mandeville Hospital, The National Spinal Injuries Centre, UK.
    Condition-related coping strategies in persons with spinal cord lesion: a cross-national validation of the Spinal Cord Lesion-related Coping Strategies Questionnaire in four community samples2007In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 45, no 6, p. 420-428Article in journal (Refereed)
    Abstract [en]

    Study design: Cross-sectional, questionnaire.

    Objectives: Coping strategies employed to manage the consequences of a spinal cord lesion(SCL) have been found to be distinctly related to emotional well-being. However, research and clinical implications have been hampered by the lack of cross-validated measures that are directly related to the lesion and its consequences. This study investigates the psychometric performance of the SCL-related Coping Strategies Questionnaire in four different countries.

    Setting: Austria, Germany, Switzerland and UK.

    Methods: The study sample comprised 355 community residing persons with SCL. Multi-trait/multi-item analysis methods and non-parametric and parametric tests were used.

    Results: The Acceptance coping scale showed satisfactory psychometric qualities, whereas there were some problems in the Fighting spirit scale and greater problems in the Social reliance scale. Compared with the Swedish developmental sample, Acceptance was used more in the four study countries. Consistent with the original sample, Acceptance and Fighting spirit coping correlated with fewer signs of emotional distress, persons lesioned 5 years or more tended to report more Acceptance than the newly lesioned and coping strategies were mainly unrelated to neurological status.

    Conclusion: The English and German language versions of the Acceptance coping scale were valid and reliable, whereas some translated items in the Fighting spirit scale need to be revised. Translations of the Social reliance scale need to be thoroughly revised and retested. The results add further evidence to the literature on the stability of the link between adapting life priorities (ie Acceptance) and emotional well-being.  

     

  • 17.
    Elfström, Magnus L
    et al.
    Health Care Research Unit, Göteborg University, Sweden.
    Kreuter, M
    Rydén, A
    Persson, L-O
    Sullivan, M
    Effects of coping on psychological outcome when controlling for background variables: A study of traumatically spinal cord lesioned persons.2002In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 40, no 8, p. 408-15Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Cross-sectional.

    OBJECTIVES: In a previous study we found spinal cord lesion (SCL)-related coping factors to be distinctly related to levels of SCL-related psychological outcome. However, we did not control for other potentially confounding variables. In this study we investigated effects of coping strategies on psychological outcome reactions in traumatically spinal cord lesioned persons controlling for sociodemographic, disability-related and social support variables.

    SETTING: The Gothenburg Spinal Injuries Unit in Sweden.

    METHODS: The study sample comprised 255 persons and a subsample of 157 persons. A series of stepwise multiple regression analyses were performed.

    RESULTS: SCL-related coping factors clearly predicted psychological outcome even when background variables were controlled. Higher levels of acceptance coping predicted decreased psychological distress and increased positive morale. Elevated social reliance coping predicted heightened distress. Higher levels of social support predicted lower feelings of helplessness. Sociodemographic and disability-related variables were weak predictors of psychological outcome with one exception: higher education predicted less bitterness and brooding.

    CONCLUSION: SCL-related coping remained the most important predictor of psychological outcome even when a wide range of variables was controlled. Thus we conclude that psychosocial interventions aimed at helping individuals develop their coping strategies might be of substantial value in their adjustment to SCL.

  • 18.
    Elfström, Magnus L.
    et al.
    Health Care Research Unit, Sahlgrenska Academy at Göteborg, Sweden.
    Kreuter, Margareta
    Department of Physiotherapy, Sahlgrenska University Hospital, Götegorg, Sweden.
    Relationships Between Locus of Control, Coping Strategies and Emotional Well-Being in Persons with Spinal Cord.2006In: Journal of clinical psychology in medical settings, ISSN 1068-9583, E-ISSN 1573-3572, Vol. 13, no 1, p. 93-103Article in journal (Refereed)
    Abstract [en]

    Relations between locus of control, coping strategies and emotional well-being in persons with traumatically acquired spinal cord lesion (SCL) were examined. The sample included 132 community-residing adults. Structural equation modelling, including confirmatory factor analysis, was used. A model was hypothesized based on the transactional theory of stress and coping where coping strategies mediated the relation between locus of control and emotional well-being. The model showed acceptable fit to the data and was compared with five alternative models. The alternative models fitted the data less well or were difficult to interpret. In the preferred model, persons indicating internal control reported more coping strategies (Acceptance, Fighting spirit) related to increased well-being, whereas persons indicating external control reported a coping strategy (Social reliance) related to poorer well-being. The findings support the stress and coping framework in medical rehabilitation and illustrate why some persons need coping effectiveness training to enhance emotional adjustment.

  • 19.
    Elfström, Magnus L.
    et al.
    Health Care Research Unit , Sahlgrenska Academy at Göteborg, Sweden.
    Kreuter, Margareta
    Department of Physiotherapy, Sahlgrenska University Hospital, Sweden.
    Persson, Lars-Olof
    Department of Nursing, Sahlgrenska Academy at Göteborg, Sweden.
    Sullivan, Marianne
    Health Care Research Unit , Sahlgrenska Academy at Göteborg, Sweden.
    General and condition-specific measures of coping strategies in persons with spinal cord lesion.2005In: Psychology, Health & Medicine, ISSN 1354-8506, E-ISSN 1465-3966, Vol. 10, no 3, p. 231-242Article in journal (Refereed)
    Abstract [en]

    We examined psychometric properties and validity of a general (Ways of Coping Questionnaire; WCQ) and a condition-specific (Spinal Cord Lesion-related Coping Strategies Questionnaire; SCL CSQ) measure of coping strategies. The sample included 181 community-residing traumatically spinal cord lesioned persons aged 16-85 years. Multi-trait/multi-item analysis, confirmatory factor analysis and multiple regression were used. Reliability and validity estimates were acceptable in most instances for the SCL CSQ, whereas the validity of the WCQ was inadequate. The SCL CSQ showed a significant relationship with the overall quality of life outcome measure, whereas the WCQ did not. We recommend condition-specific measures of coping strategies, and that the combination with coping style measures be tested in medical populations.

  • 20.
    Elfström, Magnus L
    et al.
    Health Care Research Unit, Institute of Medicine, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Lundgren, Jesper
    Berggren, Ulf
    Methodological assessment of behavioural problem dimensions in adults with dental fear2007In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 35, no 3, p. 186-94Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: In the assessment and treatment of persons with dental fear, there may be other psychological/behavioural factors than fear itself and traditional measures of psychopathology that should be considered. Longitudinal natural history studies are needed to find such variables. The present study investigated whether the same behavioural problem dimensions (internalizing, externalizing, attention) found among children and adolescents with behaviour management problems and/or dental fear could also be found among severely fearful adult patients.

    METHODS: The participants were 230 consecutive adult patients applying for treatment for severe dental anxiety at a specialized clinic. Patients completed a version of the Rutter behaviour questionnaire that was adapted for adults. Comparison data were the Hospital Anxiety and Depression scale and self-rated anger evoked by dental fear. Background data, including dental fear, were also collected. Descriptive statistics, principal components analyses, group comparisons and correlations were calculated.

    RESULTS: Of the three behaviour problems scales we adapted for adults, two (Internalizing and Attention) had acceptable psychometric properties and meaningful relations with the comparison variables. In contrast, the third problem scale (Externalizing) proved to have less satisfactory properties and relations, especially for men. Patients with severe phobia had higher levels of problem behaviours than patients with less severe phobia.

    CONCLUSIONS: Internalizing and Attention scales for adults seem promising for use in future prospective studies of the natural history of dental fear. The Externalizing scale, however, needs to be studied with a wider range of comparison variables and measures of social desirability.

  • 21. Elfström, Magnus L
    et al.
    Rydén, A
    Kreuter, M
    Persson, L-O
    Sullivan, M
    Linkages between coping and psychological outcome in the spinal cord lesioned: Development of SCL-related measures.2002In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 40, no 1, p. 23-9Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: Cross-sectional.

    OBJECTIVES: To investigate relationships between coping and mental well-being with clinical relevance to spinal cord lesion (SCL).

    SETTING: The Gothenburg Spinal Injuries Unit in Sweden.

    METHODS: The study sample comprised 274 persons. From in-depth interviews, literature reviews, and the transactional theory of stress and coping, items reflecting coping and psychological outcome, respectively were generated. Principal components factor analysis, multi-trait analysis, and structural equation modelling were used.

    RESULTS: The coping scale comprised three factors: Acceptance (i.e. revaluation of life values); Fighting spirit (i.e. efforts to behave independently); Social reliance (i.e. a tendency towards dependent behaviour). The outcome scale included the factors: Helplessness (i.e. feeling perplexed, out of control and low self-esteem); Intrusion (i.e. bitterness and brooding); Personal growth (i.e. positive outcomes of life crisis). Acceptance showed a positive relation to Personal growth and was inversely related to both Helplessness and Intrusion. Fighting spirit had a weak negative association to Helplessness and a weak positive association to Personal growth. Social reliance was positively related to Helplessness and Intrusion. Only Social reliance showed any association to neurological status. Those lesioned 1-4 years reported more Helplessness, Intrusion, Social reliance, and less Acceptance than those lesioned >or=5 years.

    CONCLUSION: Coping is related to psychological outcome in SCL. Our situational coping measure may be a candidate to assess intervention effects.

  • 22.
    Elfström, Magnus
    et al.
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Lundgren, Jesper
    Göteborgs universitet, Psykologiska institutionen.
    Arnrup, Kristina
    Department of Pedodontics, Postgraduate Dental Education Center, Örebro.
    Bodin, Lennart
    Örebro University Hospital, Clinical Research Center.
    Berggren, Ulf
    Sahlgrenska akademin vid Göteborgs universitet, Institutionen för odontologi.
    Temperamental and behavioural characteristics of adults seeking treatment for severe dental fear2009In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 24, no sup. 1, p. 162-Article in journal (Other academic)
    Abstract [en]

    Other psychological/behavioral factors in addition to fear and traditional measures of psychopathology should possibly be considered in the assessment and treatment of dental fear. The present study investigated fear and personality profiles among severely fearful adult patients. Participants were 230 consecutive adults applying for treatment of severe dental anxiety at a specialized clinic. Background data included dental treatment and dental fear history, general anxiety and depression assessments. Cluster analyses were performed. Four different fear and personality subgroups were judged to best represent data: (I) Fearful, extrovert, outgoing, (II) Highly fearful, extrovert, outgoing, (III) Fearful, inhibited, and (IV) Highly fearful, multiple problems. The view that adults with dental fear comprise a heterogeneous group was strengthened. Apart from different levels of dental fear, there seems to be varying temperamental and behavioral characteristics that need to be further studied and that may lead to a better match of treatment for these patients.

  • 23.
    Elfström, Magnus
    et al.
    Health Care Research Unit, Institute of Internal Medicine, Sahlgrenska Academy at Göteborg University, Sweden.
    Rydén, Anna
    Kreuter, Margareta
    Taft, Charles
    Sullivan, Marianne
    Relations between coping strategies and health-related quality of life in patients with spinal cord lesion2005In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, no 1, p. 9-16Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Although the use of appropriate coping strategies has been suggested to be a key factor in determining successful adjustment to severe physical illness/disability, little systematic support for this link has been found. We investigated relationships between spinal cord lesion-related coping strategies and health-related quality of life when studying for sociodemographic, disability-related and social support variables.

    DESIGN AND SUBJECTS: We studied 256 persons with traumatically acquired spinal cord lesion (=1 year) from a typical rural/urban Swedish area in a cross-sectional design.

    METHODS: Coping measure was the Spinal Cord Lesion-related Coping Strategies Questionnaire. Outcome measures were the Spinal Cord Injury Quality of Life Questionnaire, the Short-Form 36 Health Survey version 2.0, and a standardized global question of overall quality of life. Multiple regressions were performed.

    RESULTS: Coping strategies were clear correlates of health-related quality of life when sociodemographic, disability-related and social support variables were studied. The relationship between coping strategies and quality of life was: the more revaluation of life values (Acceptance) and the fewer tendencies towards dependent behaviour (Social reliance) the better the health-related quality of life.

    CONCLUSION: Our results suggest that greater focus needs to be directed to coping strategies and to ways of facilitating adaptive outcomes in rehabilitation.

  • 24.
    Elfström, Magnus
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Östlund, Gunnel
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Correlates of desire to work in persons visiting psychiatricoutpatient clinics2019In: Conference Abstracts: EHPS 19, 3 - 7 Sep 2019, Dubrovnik, Croatia, 2019Conference paper (Other academic)
    Abstract [en]

    Persons with mental health problems often express a clear desire to work, although whatfactors that contribute to this healthy aspiration are less clear. The purpose of this study thuswas to explore person, healthcare, and work-related factors in relation to desire to work inpersons visiting psychiatric outpatient clinics. The sample consisted of 272 persons visitingone of four psychiatric outpatient centres from two county councils in the south of Sweden.The possible participants were asked if they wanted to participate in research while waitingfor their scheduled appointments. A comprehensive questionnaire consisting of factors inthe research literature as well as factors advocated by patient organisations was used. Theparticipants’ ratings were analysed using non-parametric group comparisons and logisticregressions. Free-text answers were analysed by content. Higher education, better mentalhealth self-efficacy, and more experiences of demands and conflicts at the workplace wereall significantly related to desire to work in bivariate analyses. However, fighting spirit andsocial support at work had the strongest associations with desire to work in the multivariatelogistic analyses. The Nagelkerke R2 was .34. Free text answers indicated the importanceof managers’ role for the psychosocial work climate, and for receiving help with structuringthe workday to allow recovery after sickness absence. In contrast to the traditional prevocationalrehabilitation approach, and in line with a supportive work environment approach,the results points to the possibility to influence a further improved desire to work throughsupportive leadership and an open and communicative psychosocial climate.

  • 25.
    Gustafsson, Lena-Karin
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Östlund, Gunnel
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Zander, Viktoria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Anbäcken, Els-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    ‘Best fit’ caring skills of an interprofessional team inshort-term goal-directed reablement: older adults’perceptionsIn: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
  • 26.
    Kennedy, P.
    et al.
    University of Oxford.
    Lude, P.
    Swiss Paraplegic Research and Swiss Paraplegic Centre, Nottwil, Switzerland .
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare.
    Cox, A.
    Department of Clinical Psychology, National Spinal Injuries Centre, Stoke Mandeville Hospital.
    Perceptions of gain following spinal cord injury: A qualitative analysis2013In: Topics in Spinal Cord Injury Rehabilitation, ISSN 1082-0744, Vol. 19, no 3, p. 202-210Article in journal (Refereed)
    Abstract [en]

    Background: Significant research has focused on psychological difficulties following spinal cord injury (SCI), and there is a small prevalence of individuals who experience distress after injury. However, the converse is that many adjust well to injury and rate their quality of life highly. Despite this, there has been a comparative dearth of research investigating positive psychological outcomes after SCI, perceived by individuals living with this disability. Objective: To explore individuals' perceptions of gain following the experience of SCI. Methods: Participants, who had sustained an SCI between the ages 16 and 83, responded to an open-ended written question: "What do you think you have gained from the experience of spinal cord injury?" This was administered at 4 time points post injury: 6 weeks, 12 weeks, 1 year, and 2 years. Results: Participants' responses were analyzed qualitatively using the framework of thematic analysis. Thirteen themes were identified: relationships, appreciation of relationships, perspective and appreciation of life, new goals or priorities, understanding of SCI or disability, appreciation of health or health care, changed personality, opportunity or challenge, knowledge of SCI or body, newly acquired skills, spirituality, acceptance, and nothing. Descriptive statistics were incorporated in the presentation of the data. Conclusions: This study provides evidence that a broad range of positive as well as negative psychological outcomes are possible following SCI. More research is needed to better understand the process through which these outcomes arise and to inform how such outcomes may be communicated to persons experiencing this type of injury.

  • 27.
    Kennedy, Paul
    et al.
    University of Oxford, UK.
    Lude, Peter
    Nottwil and Zurich University of Applied Sciences, Suisse.
    Elfström, Magnus
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Appraisals, coping and psychological outcome measures in a European sample2009Conference paper (Other academic)
    Abstract [en]

    Study Design: Longitudinal, multiple wave panel design.

    Objectives: To investigate the degree to which current thinking in terms of early appraisals and coping, predicts adjustment and quality of life outcomes after spinal cord injury, and what degree social and demographic variables are involved.

    Setting: Data from 281 patients recruited from specialist units in selected British, Swiss, Swedish, German, Austrian and Irish spinal centres as part of an ongoing study was analysed.

    Method: Questionnaire booklets were administered as soon as possible after injury onset and after 12 weeks to patients with newly acquired spinal cord injuries.  Individuals included had sustained their injury between the ages of 16 and 83. 

    Results: Significant improvements in outcome measures were found across the data set within the first 12 weeks following spinal cord injury and changes observed in the appraisals and coping strategies employed. Significant differences were found between participating centres on both outcome measures and in the coping and appraisal processes used. Coping and appraisal processes at 6 weeks post injury were found to contribute significantly to the variation in psychological well being at 12 weeks post injury.

    Conclusion:  This study shows the process of adjustment to spinal cord injury to begin in the early stages of rehabilitation, and initial appraisals are important to how an individual will cope with their injury and to their long term psychological well being. Support is also given to the importance of psychological factors to functional outcomes.

  • 28.
    Kennedy, Paul
    et al.
    University of Oxford, UK.
    Lude, Peter
    Nottwil and Zurich University of Applied Sciences, Suisse.
    Elfström, Magnus
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Replication of the air bag effect2009Conference paper (Other academic)
    Abstract [en]

    One objective of this study was to replicate the air bag effect of persons with spinal cord injury and their close persons compared to a reference group of close persons of people with brain injury (BI) and a sample of the general population during the first year of rehabilitation.  The former psychological longitudinal study had been conducted from 1999 to 2001, the actual psychological longitudinal study from 2006 to current. The air bag effect is a creative adjustment process, characterised by a nonspecific mobilisation of coping resources which often occurs right at the onset of SCI.

    All newly acquired injuries were approached in selected Swiss, German and Austrian spinal centres.  Participants were asked to complete a questionnaire booklet at 6 weeks post injury, at 12 weeks and again one year post injury. One hundred and thirty two participants completed the questionnaire pack from 13 German speaking spinal centres.

    The air bag effect was mainly operationalized by the sense of coherence and stress related measures. The initial powerful air bag effect and its expected course could be replicated for people with SCI.  The distress of close persons of people with BI was reflected by the data.  A better development had been observed for close persons of people with SCI concerning the second and third assessment compared to the former study.

    The air bag effect can be considered as a matter of fact.  The role of psychological support is discussed in respect of mobilising resources and buffering distress.

  • 29.
    Kennedy, Paul
    et al.
    University of Oxford, Oxford Doctoral Course in Clinical Psychology and Stoke Mandeville Hospital, The National Spinal Injuries Centre, Department of Clinical Psychology.
    Lude, Peter
    Swiss Paraplegic Research and Swiss Paraplegic Centre, Nottwil.
    Elfström, Magnus
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Smithson, E
    Stoke Mandeville Hospital, The National Spinal Injuries Centre, Department of Clinical Psychology .
    Cognitive appraisals, coping and quality of life outcomes: A multi-centre study of spinal cord injury rehabilitation2010In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 48, no 10, p. 762-769Article in journal (Refereed)
    Abstract [en]

    Study design: Longitudinal, multiple wave panel design.

    Objectives: To investigate the degree to which current thinking in terms of early appraisals and coping predicts adjustment and quality of life outcomes after spinal cord injury, and to what degree social and demographic variables are involved.

    Setting: Data were analysed from 266 patients recruited as part of an ongoing study from specialist units in selected British, Swiss, German and Irish spinal centres.

    Method: Questionnaire booklets were administered as soon as possible after injury onset and after 12 weeks to patients with newly acquired spinal cord injuries. Individuals included had sustained their injury between the ages of 16 and 83.

    Results: Significant improvements in outcome measures were found across the data set within the first 12 weeks after spinal cord injury and changes observed in the appraisals and coping strategies employed. Significant differences were found between participating centres on both outcome measures and in the coping and appraisal processes used. Coping and appraisal processes at 6 weeks after injury were found to contribute significantly to the variation in psychological well-being at 12 weeks after injury.

    Conclusion: This study shows the process of adjustment to spinal cord injury to begin in the early stages of rehabilitation, and initial appraisals are important to how an individual will cope with their injury and to their psychological well-being. Support is also given to the importance of psychological factors to functional outcomes. 

  • 30.
    Kennedy, Paul
    et al.
    University of Oxford, Oxford Doctoral Course in Clinical Psychology and Stoke Mandeville Hospital, The National Spinal Injuries Centre, Department of Clinical Psychology.
    Lude, Peter
    Swiss Paraplegic Centre, Nottwil and Zurich University of Applied Sciences, School of Applied Psychology.
    Elfström, Magnus
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Smithson, E
    Stoke Mandeville Hospital, The National Spinal Injuries Centre, Department of Clinical Psychology.
    Sense of coherence and psychological outcomes in people with spinal cord injury: Appraisals and behavioural responses2010In: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 15, p. 611-621Article in journal (Refereed)
    Abstract [en]

    Study design. Longitudinal, multi-wave design.

    Objectives. To investigate the contribution of sense of coherence (SOC), appraisals, and behavioural responses when predicting psychological outcomes to spinal cord injury (SCI).

    Method. Patients (N = 237) sustaining a SCI aged 17 or above were recruited from specialist spinal injuries centres across six European countries. Measures of SOC, appraisals, coping strategies, and psychological well-being were administered at 6 and 12 weeks post-injury and at a 1 year follow-up.

    Results. People scoring high on SOC at 6 weeks post-injury showed significantly better psychological outcomes at 1 year post-injury and SOC showed significant relationships with appraisals at 12 weeks post-injury and coping strategies 1 year postinjury. Significant relationships were found between appraisals at 12 weeks post-injury and psychological outcomes, adaptive coping strategies were significantly related to psychological well-being at 1 year post-injury. Regression analyses found SOC, appraisals, and coping behaviours to explain 61.8% of the variance in psychological quality of life, 66.5% of the variance in depression, and 37.7% of the variance in anxiety at 1 year post-injury. 

    Conclusion. This study provides further evidence in support of previous findings which suggest SOC to have a primary role in long-term psychological well-being. The relationship described here – from SOC to the appraisal of injury and subsequent behavioural responses – suggests SOC to be an influential factor in the long-term adjustment of people with SCI.

  • 31.
    Kennedy, Paul
    et al.
    University of Oxford, Oxford Doctoral Course in Clinical Psychology and Stoke Mandeville Hospital, The National Spinal Injuries Centre, Department of Clinical Psychology.
    Lude, Peter
    Swiss Paraplegic Centre, Nottwil and Zurich University of Applied Sciences, School of Applied Psychology.
    Elfström, Magnus
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Smithson, Emily
    Stoke Mandeville Hospital, The National Spinal Injuries Centre, Department of Clinical Psychology.
    Appraisals, coping and adjustment pre and post rehabilitation: A 2-year follow-up study2012In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 50, no 2, p. 112-118Article in journal (Refereed)
    Abstract [en]

    Study Design: Longitudinal, multi-wave panel design.

    Objectives: To explore the changes in and the relationships between appraisals and coping with mood, functioning and quality of life pre and post rehabilitation for acute spinal cord injury.

    Setting: The data collected was part of an ongoing study from specialist units in selected British, Swiss, German, and Irish spinal cord injury centres.

    Method: Questionnaires (Functional Independence, Quality of Life, Mood, Appraisals, Coping & Support) were administered to 232 patients at 12 weeks post injury and sent to participants at 1 and 2 years post injury by post.

    Results: Significant changes were observed in various outcome measures between 12 weeks and 1 year post injury, with little significant change occurring during the following year. Appraisals and coping at 12 weeks post injury were significantly related to outcome scores and also contributed significantly to the variance in quality of life, mood, and stress related growth at 2 years post injury.

    Conclusion:  The study provides further evidence for the link between appraisals, coping and subsequent adjustment to injury. Suggestion is made for the potential benefit of early assessment and intervention for patients at risk of poor adjustment to SCI.

  • 32.
    Kennedy, Paul
    et al.
    University of Oxford, Oxford Doctoral Course in Clinical Psychology and Stoke Mandeville Hospital, The National Spinal Injuries Centre, Department of Clinical Psychology.
    Lude, Peter
    Swiss Paraplegic Centre, Nottwil and Zurich University of Applied Sciences, School of Applied Psychology.
    Elfström, Magnus
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Smithson, Emily
    Stoke Mandeville Hospital, The National Spinal Injuries Centre, Department of Clinical Psychology.
    Psychological contributions to functional independence: A longitudinal investigation of spinal cord injury rehabilitation2011In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 92, no 4, p. 597-602Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the contribution of pre-rehabilitation appraisals of spinal cord injury and patient’s coping strategies to the variance in functional independence post discharge.

    Design: Longitudinal, cohort study. Patients sustaining a spinal cord injury aged 16 or above were recruited from English and German speaking specialist spinal injuries centres. Measures of appraisals, coping strategies, mood and functional independence were administered on commencing active rehabilitation (12 weeks post injury) and following hospital discharge (1 year post injury).

    Setting: Specialist spinal cord injury rehabilitation centres in England,Germany,Switzerland andIreland.

    Participants: One hundred and twenty seven patients completed questionnaires at both time points. Sample age ranged between 17.5 and 64.5 with a mean age of 39.3. Demographic and injury characteristics were similar to those reported in international statistics databases.

    Interventions: Not Applicable

    Main Outcome Measure:  Functional Independence Measure (FIM; motor subscale).

    Results: Injury characteristics, age, gender, current depression and the utilization of the coping strategy ‘social reliance’ at twelve weeks post injury explained 33.5% of the variance in motor FIM at one year post injury. Strong relationships were found between appraisals, coping styles, mood and functional outcomes.

    Conclusion: The coping strategy ‘Social Reliance’ was found to contribute significantly when explaining the variance in functional outcomes. Suggestions are made to assess appraisals and coping strategies early in rehabilitation in order to provide effective interventions and additional support to those scoring highly on negative coping styles. Further research would be recommended to provide support for the relationship between dependent coping strategies and functional outcomes.

  • 33.
    Lude, P.
    et al.
    Swiss Paraplegic Research, Nottwil, Switzerland.
    Kennedy, P.
    University of Oxford, United Kingdom.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Ballert, C. S.
    Swiss Paraplegic Research, Nottwil, Switzerland.
    Quality of life in and after spinal cord injury rehabilitation: A longitudinal multicenter study2014In: Topics in Spinal Cord Injury Rehabilitation, ISSN 1082-0744, Vol. 20, no 3, p. 197-207Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the changes in quality of life (QOL) in persons with spinal cord injury (SCI) and their close persons during the first 2 years post injury. Method: Longitudinal, multiple sample, multiple wave panel design. Data included 292 patients recruited from Austrian, British, German, Irish, and Swiss specialist SCI rehabilitation centers and 55 of their close persons. Questionnaire booklets were administered at 6 weeks, 12 weeks, 1 year, and 2 years after injury to both samples. Results: Study 1 investigated the WHOQOL-BREF domains in individuals with SCI and found differences mostly in the physical domain indicating that QOL increases for persons with SCI from onset. An effect of the culture was observed in the psychological and environmental domains with higher QOL scores in the German-speaking sample. Study 2 compared individuals with SCI to their close persons and found differences in the physical, environmental, and social domains over time. The scores on the psychological dimension did not significantly differ between the persons with SCI and their close persons over time. Conclusion: QOL measured by the WHOQOL-BREF shows that QOL changes during rehabilitation and after discharge. Apart from the physical dimension, the persons with SCI and their close persons seem to experience a similar change in QOL. Further longitudinal research is suggested to clarify the mutual adjustment process of people with SCI and their close persons and to explore cultural differences in QOL between English- and German-speaking countries.

  • 34.
    Lundgren, Jesper
    et al.
    Department of Psychology, Göteborg University, Göteborg, Sweden.
    Elfström, Magnus L
    Health Care Research Unit, Institute of Medicine, Göteborg university, Göteborg, Sweden.
    Berggren, Ulf
    Dental Behavioural Sciences Unit, Institute of Odontology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    The relationship between temperament and fearfulness in adult dental phobic patients.2007In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 17, no 6, p. 460-8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Temperament has been associated with dental fear (DF) and dental behavioural management problems (DBMP) in children, but little is known about what role temperament plays in the aetiology of DF. Thus, measures of temperament suitable for use among children, adolescents, and adults would be of value for longitudinal and family studies of DF, where relations between children's and parent's ratings are investigated.

    AIM: Our aim was to explore the adapted EASI (emotionality, activity, sociability, and impulsivity) in adult patients, and to evaluate the instrument in comparison with established measures of DF and general emotional reactions in adults.

    DESIGN: The subjects were 230 adult patients applying for treatment for DF and 41 nonfearful patients (reference group). Questionnaires investigated temperament (general and DF) and general anxiety and depression.

    RESULTS: The previously described factor structure of the EASI among children was confirmed and the adapted EASI had acceptable psychometric qualities. Emotionality correlated with DF and with measures of general psychological distress. No differences were found in mean scores of EASI dimensions between DF group and the reference group, which was in contrast with studies in children.

    CONCLUSIONS: The adapted EASI seem promising for use in future longitudinal and familial studies of development of DF and DBMP.

  • 35.
    Migliorini, Christine E
    et al.
    Monash University, Centre for Developmental Psychiatry and Psychology.
    Elfström, Magnus
    Sahlgrenska akademin vid Göteborgs universitet, Institutionen för medicin, Sektionen för vårdforskning.
    Tonge, Bruce J
    Monash University, Centre for Developmental Psychiatry and Psychology.
    Translation and Australian validation of the spinal cord lesion-related coping strategies and emotional wellbeing questionnaires2008In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 46, no 10, p. 690-695Article in journal (Refereed)
    Abstract [en]

    Study design: Representative community cross-sectional self-report survey of adults with spinal cordinjury (SCI).

    Objectives: To establish semantic translation and validation of the Swedish scales -- the Spinal Cord Lesion Coping Strategies Questionnaire and the Spinal Cord Lesion Emotional Wellbeing Questionnaire.

    Setting: Adults on the Victorian traumatic SCI register and attendees of the nontraumatic outpatient clinic were invited to participate.

    Methods: Instruments were forward and backward translated to establish semantic equivalence. Principle components analyses were undertaken. Correlation and logistic regression analyses were conducted to demonstrate validity of the instruments using both positive (high quality of life) and negative (depression and anxiety) psychological outcomes.

    Results: The final sample consisted of 443 adults with SCI living in the community. Both instruments demonstrated acceptable psychometric properties. Univariate correlation analyses showed most of the new scale components displayed medium to large relationships in the expected direction with the psychological outcomes and the other subscales. Health status and helplessness were significant predictors of both the positive and negative psychological outcomes in the logistic regression analyses. Acceptance was significantly related to the positive outcome only. Female and incomplete tetraplegia categories were significantly and positively related to depression only.

    Conclusion: Notwithstanding a few issues with some of the subscales, the results support the usefulness of these easy to use instruments and point to ways for further development of the scales. 

  • 36.
    Nahlen Bose, Catarina
    et al.
    Röda Korsets Högskola, Sweden.
    Björling, Gunilla
    Röda Korsets Högskola, Sweden.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Persson, Hans
    Karolinska Institutet, Sweden.
    Saboonchi, Fredrik
    Röda Korsets Högskola, Sweden.
    Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured2015In: Cardiology Research, ISSN 1923-2829, E-ISSN 1923-2837, Vol. 6, no 2, p. 239-248Article in journal (Refereed)
    Abstract [en]

    Background: Individuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief COPE, a self-reporting questionnaire, has been previously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for grouping the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associations between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF.

    Method: One hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strategies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regression analyses explored associations of aggregated coping strategies with HRQoL.

    Results: A four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused coping, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF.

    Conclusions: This study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assessment of coping both in clinical and research settings.

  • 37. Nahlen Bose, Catarina
    et al.
    Elfström, Magnus L.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Björling, Gunilla
    Persson, H
    Saboonchi, Fredrik
    Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failureManuscript (preprint) (Other academic)
  • 38.
    Nahlen Bose, Catarina
    et al.
    The Swedish Red Cross University College, Stockholm, Sweden.
    Persson, Hans
    Karolinska Institutet, Stockholm, Sweden.
    Björling, Gunilla
    The Swedish Red Cross University College, Stockholm, Sweden.
    Ljunggren, Gunnar
    Karolinska Institutet, Stockholm, Sweden.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Stockholm, Sweden.
    Evaluation of a Coping Effectiveness Training intervention in patients with chronic heart failure: a randomized controlled trial2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 7, p. 537-548, article id S1-S1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Impaired emotional well-being has detrimental effects on health outcomes in patients with chronic heart failure (CHF).

    AIMS:

    To evaluate a nurse-led Coping Effectiveness Training (CET) group intervention for patients with CHF. It was hypothesized that CET would increase emotional well-being (primary outcome) and health-related quality (HRQoL) of life and improve clinical outcomes. Furthermore, changes in appraisal and coping as mediators of the intervention effect were examined.

    METHODS:

    Participants were randomized to either control group (n=51) receiving standard health care or CET intervention group (n=52). Self-assessments of positive affect, negative affect, depression, anxiety, HRQoL, illness perception, coping strategies and social support were performed pre- and post-intervention and after six weeks, six months and 12 months. Time to death and hospitalizations were measured during the entire follow-up (median 35 months, interquartile range 11 months).

    RESULTS:

    No significant improvements for emotional well-being and HRQoL in the intervention group compared with the control group were found. After excluding patients with clinical anxiety and depression at baseline the intervention group had significantly lower negative affect (p = 0.022). There were no significant differences regarding cardiovascular events between the groups. The intervention group had greater sense of control over their illness in the short-term (p = 0.036).

    CONCLUSION:

    CET intervention was found to increase sense of control over the illness in the short term. Psychosocial support programmes, like CET, for patients with CHF is currently lacking evidence for implementing in clinical practice. However, the results provide a basis for future studies with a modified CET intervention design and increased study size.

  • 39.
    Nahlen, C.
    et al.
    Sophiahemmet Univ C, Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Bjorling, G.
    Sophiahemmet Univ C, Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Malardalen Univ, Dept Psychol, Vasteras, Sweden..
    Persson, H.
    Saboonchi, F.
    Stockholm Univ, Sophiahemmet Univ C, Danderyd Hopsital, Karolinska Inst, S-10691 Stockholm, Sweden..
    Anxiety in patients with chronic heart failure: impact of perception of control and acceptance coping2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, p. 763-763Article in journal (Other academic)
  • 40.
    Nahlen, C.
    et al.
    Sophiahemmet Univ C, Karolinska Inst, Sw3eden.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Björling, G.
    Karolinska Institute, Sweden.
    Persson, H.
    Karolinska Institute, sweden.
    Saboonchi, F.
    Karolinska Institute, Sweden.
    The role of illness perception and avoidant coping for depression in patients with chronic heart failure2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, p. S52-S53Article in journal (Refereed)
  • 41.
    Nahlen, C.
    et al.
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden..
    Saboonci, F.
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden..
    Bjorling, G.
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden..
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Persson, H.
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden..
    Anxiety in patients with chronic heart failure: impact of perception of control and acceptance coping2012In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 27, p. 286-287Article in journal (Other academic)
  • 42.
    Nahlén Bose, C.
    et al.
    The Swedish Red Cross University College, Stockholm, Sweden .
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Björling, G.
    The Swedish Red Cross University College, Stockholm, Sweden.
    Persson, H.
    Karolinska Institutet, Stockholm, Sweden.
    Saboonchi, F.
    Karolinska Institutet, Stockholm, Sweden.
    Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 4, p. 704-713Article in journal (Refereed)
    Abstract [en]

    Introduction: Emotional distress in patients with chronic heart failure (CHF) predicts mortality, hospital readmission and quality of life. The patient's avoidant coping style and beliefs about the disease have been linked to emotional distress in CHF. However, the pattern and transmitting effects of these variables are indefinite. Aim: This study aimed to examine the links between and the potential mediating role of illness perceptions and avoidant coping style on depression and anxiety in patients with CHF. Method: Self-assessment data from 103 patients with CHF were subjected to path analysis in two hypothesised models. The outcome measures were coping styles, illness perception, anxiety and depression. Results: Avoidant coping had a direct adverse effect on anxiety and depression. The perception of symptom burden and personal control, significantly mediated the effect between avoidant coping and anxiety and depression. Conclusions: Avoidant coping style appears to influence not only emotional distress, but also a malignant symptom perception and low sense of control over the illness.

  • 43.
    Nicklasson, Mercedes
    et al.
    Institution of Medicine, Sahlgrenska Academy, University of Gothenburg.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare.
    Olofson, J
    Institution of Medicine, Sahlgrenska Academy, University of Gothenburg.
    Bergman, Bengt
    Institution of Medicine, Sahlgrenska Academy, University of Gothenburg.
    The impact of individual quality of life assessment on psychosocial attention in patients with chest malignancies: A randomized study2013In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 21, no 1, p. 87-95Article in journal (Refereed)
    Abstract [en]

    Purpose

    The aims of this study were to investigate the impact of individual health-related quality of life (HRQL) evaluation on the attention towards symptom control and psychosocial function in advanced cancer patients.

    Methods

    Patients with advanced lung cancer or mesothelioma who attended a pulmonary oncology outpatient clinic were randomized to either of two strategies for HRQL assessment. The experimental group (EG) answered the EORTC QLQ-C30 + LC13 questionnaire using a digital table interface, with outprint of aggregated scale scores presented to the consulting physician as a support for evaluation. The control group (CG) answered a paper version of the same questionnaire, which was stored for later analysis. Consultations were audio-recorded. Outcome measures were a quantitative content analysis of audio-recorded consultations and medical and psychosocial interventions abstracted from clinical records.

    Results

    One hundred seventy-one patients were randomized and participated in the study. Issues regarding emotional function were more frequently discussed during consultations in the EG (p < 0.05). Similarly, interventions directed to emotional and social concerns were more frequent in the EG (p = 0.013 and p = 0.0036, respectively). HRQL measures over time were similar across the groups.

    Conclusion

    Individual HRQL assessment increased the attention to psychosocial functioning in patients with chest malignancies.

  • 44.
    Paker, N.
    et al.
    Istanbul PMR Edu Hosp, Dept PMR, Istanbul, Turkey.
    Bugdayci, D.
    Istanbul PMR Edu Hosp, Dept PMR, Istanbul, Turkey.
    Kesiktas, N.
    Istanbul Mehmet Akif Ersoy GKDC Edu Hosp, Turkey.
    Sahin, M.
    Istanbul PMR Edu Hosp, Dept PMR, Istanbul, Turkey.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Reliability and validity of the Turkish version of spinal cord lesion-related coping strategies2014In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 52, no 5, p. 383-387Article in journal (Refereed)
    Abstract [en]

    Objective: Spinal Cord Lesion-Related Coping Strategies Questionnaire (SCL CSQ) is a specific test that is developed for evaluating the coping strategies of the persons with spinal cord injury (SCI). The aim of this study was to evaluate the reliability and validity of the Turkish version of SCL CSQ (SCL CSQ-T) in persons with SCI. Methods: One hundred persons with SCI were included in the study. All participants were evaluated with SCL CSQ-T and Brief Coping Styles Inventory (BCSI) at the baseline. SCL CSQ-T was repeated twice in 15 days. American Spinal Injury Association Impairment Scale and Functional Independence Measurement were used for the evaluation of the neurological loss severity and functional status. Emotional status was assessed by Hospital Anxiety and Depression Scale (HADS). Internal consistency reliability, test-retest reliability and construct validity of SCL CSQ-T were evaluated. Results: Intraclass correlation coefficients of the SCL CSQ-T were between 0.51-0.86. Cronbach's alpha values and test-retest reliability of the acceptance, fighting spirit and social reliance subscales were good. Three factors were found in exploratory factor analysis. There was a positive correlation between the subscales of SCL CSQ-T. There was a statistically significant positive correlation between acceptance strategy of SCL CSQ-T and self-confidence and optimism of BCSI. The fighting spirit strategy positively correlated with self-confidence and optimistic strategies. The social reliance strategy positively correlated with helplessness and seeking social support. Coping strategies did not correlate with HADS. Conclusion: The results of this study revealed good internal consistency reliability, test-retest reliability and concurrent validity of the SCL CSQ-T factors acceptance and fighting spirit in relation to general coping strategies. The coping strategy social reliance needs revisions.

  • 45.
    Saurí, J
    et al.
    Àrea de Rehabilitació NeuroPsicoSocial, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autònoma de Barcelona, Badalona, Spain [2] Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain [3] Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
    Umaña, M C
    Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain [2] Unidad de Salud Mental, Hospital Universitario San Ignacio, Bogotá, Colombia..
    Chamarro, A
    Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain [2] Department of Basic Psychology, Faculty of Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain..
    Soler, M D
    Àrea de Rehabilitació NeuroPsicoSocial, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autònoma de Barcelona, Badalona, Spain [2] Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain [3] Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain..
    Gilabert, A
    Àrea de Rehabilitació NeuroPsicoSocial, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autònoma de Barcelona, Badalona, Spain [2] Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain [3] Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain..
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Adaptation and validation of the spanish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL CSQ-S).2014In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 52, no 11, p. 842-849Article in journal (Refereed)
    Abstract [en]

    CONCLUSION: The results of the study show some evidence for the robustness of the structure of SCL CSQ-S and show that the Spanish version of the questionnaire largely replicate previous results. Coping strategies, especially Acceptance, are related to adaptation to injury.

    STUDY DESIGN: Cross-sectional validation study.

    OBJECTIVES: To adapt the Spinal Cord Lesion-related Coping Strategies Questionnaire into the Spanish language (SCL CSQ-S) and to examine the relationship between coping strategies, global quality of life and psychological adaptation.

    SETTING: Data were collected through individuals with spinal cord injury (SCI) now living in the community who completed their routine follow-up assessment at the Institute Guttmann in Barcelona, Spain.

    METHODS: Forward and backward translation into Spanish of the English version of the questionnaire. Questionnaires of global Quality of Life, Community Integration, Coping, Depression, Anxiety and Functional Independence were administered to 349 adults with paraplegia and 162 adults with tetraplegia. Statistical analysis included confirmatory factor analysis and regression analysis.

    RESULTS: The factorial structure of the questionnaire was partly verified. The original correlated, three-factor model sufficiently fit the data obtained in this study: χ(2)(48)=109.46; P<0.001; Comparative Fit Index=0.96; Tucker-Lewis Index=0.96; Root Mean Square Error of Approximation=0.050 (0.038-0.062); Akaike information criterion=13.46. Items were found to be good indicators of their respective latent factors, showing adequate factorial charge ranges (between 0.41 and 0.75). The reliability coefficient (Cronbach's α) for the Acceptance subscale was 0.74, for Social reliance 0.76 and for Fighting spirit 0.69. Coping strategies as measured by SCL-CSQ-S contributed to the prediction of outcomes related to adaptation to disability.

  • 46.
    Umaña Ruiz, C
    et al.
    Universidad Autónoma de Barcelona, Institut Guttmann de Neurorrehabilitación.
    Sauri, J
    Universidad Autónoma de Barcelona, Institut Guttmann de Neurorrehabilitación.
    Chamarro, A
    Universidad Autónoma de Barcelona, Institut Guttmann de Neurorrehabilitación.
    Soler, D
    Universidad Autónoma de Barcelona, Institut Guttmann de Neurorrehabilitación.
    Gilabert, A
    Universidad Autónoma de Barcelona, Institut Guttmann de Neurorrehabilitación.
    Nuñez, A
    Universidad Autónoma de Barcelona, Institut Guttmann de Neurorrehabilitación.
    Gifre, M
    Universidad Autónoma de Barcelona, Institut Guttmann de Neurorrehabilitación.
    Elfström, Magnus
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Fernández-Castro, J
    Universidad Autónoma de Barcelona, Institut Guttmann de Neurorrehabilitación.
    Estudio piloto para la adaptación al casteliano del cuestionario de estrategias de afrontamiento a la lesión medular (SCL CSQ)2010In: S.E.A.S Libro de Resúmenes 2010, 2010, p. 279-279Conference paper (Other academic)
  • 47.
    Yuwanich, Nuttapol
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Rangsit Univ, Sch Nursing Sci, Ptumthani, Thailand..
    Akhavan, Sharareh
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Nantsupawat, Walaiporn
    Rangsit Univ, Sch Nursing Sci, Ptumthani, Thailand..
    Martin, Lene
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sandborgh, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Development and psychometric properties of the stressor scale for emergency nurses2018In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 39, p. 77-88Article in journal (Refereed)
    Abstract [en]

    Introduction: Emergency department nurses are exposed to specific stressors and report higher stress levels than nurses in other hospital departments. This study aimed to develop and test the psychometric properties of a questionnaire-based instrument for identifying stressors for emergency department nurses. Methods: The instrument's content and face validities were examined by five experts and nurses in emergency nursing field. The test-retest reliability was examined on 30 emergency department nurses. The construct validity, including an exploratory and a confirmatory factor analysis, was tested on 405 emergency department nurses. Cronbach's alpha values and intra-class coefficients were calculated. Results: The instrument's content and face validities were satisfactory. The exploratory factor analysis provided a five-factor solution, whereas the confirmatory factor analysis provided a final four-factor solution with 25 items distributed among the factors Life and death situations, Patients' and families' actions and reactions, Technical and formal support, and Conflicts. The Cronbach's alpha values ranged from 0.89 to 0.93 per factor, and the intra-class correlation coefficient was 0.89, indicating good homogeneity and stability. Conclusions: The instrument's content, face, and construct validities were satisfactory, and the internal consistency and test-retest reliability were good. This instrument can be useful in the management of emergency departments.

  • 48.
    Östlund, Gunnel
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Zander, Viktoria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gustafsson, Lena-Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Anbäcken, Els-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    “It gets easier when the sun is shining”: a follow-up study after a reablement intervention2017Conference paper (Refereed)
  • 49.
    Östlund, Gunnel
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Zander, Viktoria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elfström, Magnus
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gustafsson, Lena-Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Anbäcken, Els-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Older adults’ experiences of a reablement process.: "To be treated like an adult, and ask for what I want and how I want it"In: Educational gerontology, ISSN 0360-1277, E-ISSN 1521-0472Article in journal (Refereed)
    Abstract [en]

    This is a follow-up study of intensive home-based rehabilitation from older people’s perspectives. The aim was to explore older adults’ descriptions of interactional needs related to autonomy in life. The purpose was also to explore the importance of significant others in the reablement process.

    Method: The sample consisted of 23 women aged 72–92 who were included consecutively in the first project year. Data were collected through face-to-face semi-structured interviews that were recorded, transcribed, and analyzed using qualitative latent content analysis.

    Results: Regaining autonomy through reablement was achieved by the interviewees although not always to the same extent as before. Three themes related to interactional needs were identified: (1) Transitional relations, referring to encounters with staff in time-limited relations. (2) More stable relations with significant others without limitation of time. (3) The acceptance of growing older and of death as a “natural departure”. Transitional relations with professionals, and more stable relations with significant others, are important parts of the reablement process according to older adults.

    In conclusion: Professionals within gerontology need to recognize the social and historical context including the symbolic meanings each older person gives to life’s necessaries. Older adults appreciate reablement which includes rehabilitation goals related to the person’s stable relationships and larger life context.

  • 50.
    Östlund, Gunnel
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Zander, Viktoria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Elfström, Magnus, L.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Gustafsson, Lena-Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Anbäcken, Els-Marie
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    ´Nothing to do about it, simply hang on´ - Older women´s experiences of social and existential health after a reablement intervention2018Conference paper (Other academic)
1 - 50 of 50
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